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Coulson E, Saravanan V, Hamilton J et al. Ann Rheum Dis 2011;70:1289–91.

Concerns have been raised that methotrexate treatment reduces the efficacy of immunization against pneumococcus in rheumatoid arthritis (RA) patients. These authors conducted an evaluation of data on immunization, pneumococcal infections, and RA treatments over a 10-year period. Pneumococcal antibody levels were also evaluated. No correlation was found between pneumococcal antibody levels and methotrexate dose, methotrexate treatment duration, or time since vaccination.


Increased morbidity and mortality in rheumatoid arthritis (RA) patients arises partly due to infections, in particular infections of the lower respiratory tract. Immunization against pneumococcus (e.g. with Pneumovax®, Merck) has been shown to reduce pneumonia in RA patients. There is concern that methotrexate may interfere with the efficacy of pneumococcal vaccination with Pneumovax but so far there have been no objective data confirming this possibility.

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